Indigenous Youth Peer-Led Health Promotion in Canada, New Zealand, Australia, and the United States: A Systematic Review of the Approaches, Study Designs, and Effectiveness

Abstract

BackgroundYouth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness.MethodsA systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers.ResultsTwenty-four studies were identified for inclusion, based on 20 interventions (9 Australian, 4 Canadian, and 7 from the United States of America). Only one intervention was evaluated using a randomized controlled study design. The majority of evaluations took the form of pre–post studies. Methodological limitations were identified in a majority of studies. Study outcomes included improved knowledge, attitude, and behaviors.ConclusionCurrently, there is limited high quality evidence for the effectiveness of peer-led health interventions with Indigenous young people, and the literature is dominated by Australian-based sexual health interventions. More systematic research investigating the effectiveness of peer-led inventions is required, specifically with Indigenous populations. To improve health outcomes for Indigenous youth, greater knowledge of the mechanisms and context under which peer-delivered health promotion is effective in comparison to other methods of health promotion is needed.

A Pragmatic Review to Assist Planning and Practice in Delivering Nutrition Education to Indigenous Youth

“…Children can also have a powerful influence on the knowledge and understanding of other children and some school-based interventions have used children as change agents among their peers and to influence their family [37]. A number of studies that have utilised peer-led interventions to educate Australian Indigenous youth on sensitive health topics, resulting in improved behavioural outcomes and an increase in knowledge [23]. Although few studies describe the approach of children as change agents or peer-led interventions for Australian Indigenous communities, those studies that exist on peer-led health interventions in Australian Indigenous youth show evidence of changes in knowledge and attitudes.…”

“…Although few studies describe the approach of children as change agents or peer-led interventions for Australian Indigenous communities, those studies that exist on peer-led health interventions in Australian Indigenous youth show evidence of changes in knowledge and attitudes. However, there is limited knowledge on the mechanisms under which peer-led health interventions are effective, suggesting a need for more research and evaluation of projects in this area [23].…”

“…Engaging local people as experts in program delivery will also help to ensure programs are more suitable for the widely different contexts in which Indigenous people live, in terms of geography, climate, socioeconomic circumstances, food availability and food security. Culturally appropriate programs have been designed to empower children and adolescents to motivate behavioural changes when interacting with other peers [23]. This suggests the need to view children and adolescents as the promoters of health in their immediate surroundings.…”

Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda

“…The field of graphic medicine employs comics as a medium for patient care and education, using the juxtaposition of visual messages alongside text to convey emotions and underlying meaning [34]. Comics offer a youth-friendly, low-cost, scalable approach for providing education [35,36]. This approach is accessible, does not require high levels of literacy, and can engage persons in reflection on emotionally difficult and often stigmatized issues [37].…”

Evaluation of the Young Deadly Free Peer Education Training Program: Early Results, Methodological Challenges, and Learnings for Future Evaluations

“…The prevailing assumption of peer-led approaches is that individuals are more inclined to personalize a message and change their behavior and/or attitude if the messenger is perceived to have similar characteristics or share similar concerns to oneself (14). While there is a dearth of literature reporting on the efficacy of peer education in addressing sexual health issues among young Indigenous people in the Australian context [e.g., (15)], a recent literature review of international Indigenous youth peer-led health promotion programs found some evidence to suggest that Indigenous peer health education is associated with positive outcomes (16). Specifically, among the studies reviewed, there were reports of improvements in knowledge, awareness, and attitudes, along with an increased use of health services and STI/BBV testing.…”